title: Very mild dementia and medical comorbidity independently predict health care use in the elderly.
abstract: OBJECTIVE
  To determine whether dementia status and medical burden were independent predictors of emergency department (ED) visits and hospitalizations in older patients from an urban geriatric practice participating in a primary care based cognitive screening program.
  
  
  METHODS
  A comprehensive chart review was conducted for 300 African American and Caucasian patients, including 46 with prevalent dementia and 28 with incident dementia using the Cumulative Illness Burden Scale. Hospital-based claims data was used to retrieve ED visits and hospital admissions for 5 years following baseline assessment.
  
  
  RESULTS
  Patients with dementia had a 49% higher rate of ED visits (IRR = 1.49; 95% CI = 1.06, 2.09) and an 83% higher risk of death than patients without dementia (HR = 1.83; 95% CI = 3.07, 0.03). Dementia status predicted hospital admissions after adjustment for medical burden (IRR = 1.37; 95% CI = 0.99, 1.89). For each one point increase in medical burden, there was an 11% increase in ED visits (IRR = 1.11; 95% CI = 1.06, 1.16), a 13% increase in hospital admissions (IRR = 1.13; 95% CI = 1.09, 1.17), and an 11% higher risk of death (HR = 1.11; 95% CI = 1.04, 1.17). Age did not predict utilization.
  
  
  CONCLUSIONS
  Dementia status and medical burden were independent predictors of ED visits and death in patients with clinically diagnosed dementia followed from the early stage of disease.
authors.affiliation: Albert Einstein College of Medicine and Montefiore Medical Center, Department of Neurology, Bronx, NY, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Grober
authors.forename: Amy
authors.initials: A
authors.lastname: Sanders
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.forename: Amy R
authors.initials: AR
authors.lastname: Ehrlich
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
keywords: acute care utilization; dementia; emergency department visits; hospitalizations; primary care